From the Guidelines
Thrombophilia alone is not an indication for cesarean section (CS). Most women with thrombophilia can safely deliver vaginally. The presence of thrombophilia increases the risk of venous thromboembolism (VTE) during pregnancy and postpartum, but this risk should be managed with appropriate anticoagulation therapy rather than by changing the mode of delivery.
Key Considerations
- The decision for CS should be based on standard obstetric indications such as fetal distress, failure to progress in labor, placental abnormalities, or maternal conditions that make vaginal delivery unsafe.
- For pregnant women with thrombophilia who are on anticoagulation therapy, careful planning of delivery is important, including appropriate timing of discontinuation and resumption of anticoagulants around delivery.
- Regional anesthesia considerations may also be necessary if the patient is anticoagulated.
- The management should focus on preventing thrombotic complications through risk assessment, prophylactic or therapeutic anticoagulation as indicated, and close monitoring, rather than defaulting to cesarean delivery.
Recommendations
- All women who undergo cesarean delivery should receive sequential compression devices starting before surgery and that the compression devices be used continuously until the patient is fully ambulatory 1.
- Women with a previous personal history of deep venous thrombosis or pulmonary embolism who undergo cesarean delivery should receive both mechanical and pharmacologic prophylaxis 1.
- Women with a personal history of an inherited thrombophilia (high-risk or low-risk) but no previous thrombosis who undergo cesarean delivery should receive both mechanical and pharmacologic prophylaxis 1.
From the Research
Thrombophilia and Cesarean Section
- Thrombophilia is a condition characterized by an increased risk of thrombosis, which can be a concern during pregnancy and after cesarean section (CS) 2, 3, 4, 5, 6.
- Studies have investigated the use of thromboprophylaxis after CS, including the use of low-molecular-weight heparin (LMWH), intermittent pneumatic compression (IPC), and elastic stockings (ES) 2, 3, 5.
- The evidence suggests that thromboprophylaxis may be beneficial in preventing venous thromboembolism (VTE) after CS, particularly in women with thrombophilia or other risk factors 2, 3, 4, 6.
- However, the optimal method of thromboprophylaxis after CS is still unknown, and clinical practice varies widely 5.
Risk Factors for Thrombosis after CS
- Thrombophilia is a significant risk factor for thrombosis after CS 2, 3, 4, 6.
- Other risk factors for thrombosis after CS include increased body mass index (BMI), emergency CS, and older maternal age 5.
- Women with a personal or family history of thrombosis or poor pregnancy outcome should undergo laboratory testing to determine their risk of thrombosis 6.
Thromboprophylaxis after CS
- LMWH is a commonly used method of thromboprophylaxis after CS, particularly in women with thrombophilia or other risk factors 2, 3, 5.
- IPC and ES are also used as methods of thromboprophylaxis after CS, although their effectiveness is less well established 2, 5.
- The duration of thromboprophylaxis after CS varies, but it is typically continued for at least 6 weeks after delivery 6.